title: Feasibility of early discharge strategies for neutropenic fever: outcomes of a Victorian organisational readiness assessment and pilot.
abstract: BACKGROUND
  Although Australian consensus guidelines support the use of ambulatory care strategies for management of adult patients with low-risk neutropenic fever (NF), few centres have successfully implemented viable programmes.
  
  
  OBJECTIVE
  To study the feasibility of an early discharge programme for adult patients with low-risk NF and assess organisational factors likely to influence successful implementation across participating Victorian hospitals.
  
  
  METHODS
  Four hospitals participated in an organisational readiness assessment preceding selection of a pilot site for programme implementation. Prospective baseline auditing of current practice (i.e. inpatient care until resolution of NF) across three hospitals preceded programme implementation and evaluation.
  
  
  RESULTS
  Barriers and facilitators to successful implementation were identified. One hundred and seventeen NF episodes were evaluated during audit phases. The frequency of low-risk NF presentations eligible for early discharge was low (less than two episodes per week). The programme reduced median (interquartile range) duration of parenteral antibiotics and length of stay for eligible patients (n = 11) from 4 (4, 5) days at baseline to 1 (1, 2) day during pilot (P = 0.02) and 4.5 (4, 5) days (baseline) to 2 (1, 3) days (pilot) (P = 0.02) respectively. The proportion of ineligible patients stepped down to oral antibiotics was improved from 38% (baseline) to 67% (pilot). No patients failed ambulatory care requiring readmission into hospital.
  
  
  CONCLUSIONS
  The ambulatory care strategy for management of NF proposed by Australian consensus guidelines has been successfully piloted at a single Victorian centre. Organisational readiness tools can be used to identify potential barriers to the implementation of evidence based practices in patients with NF.
authors.affiliation: Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. senthil.lingaratnam@petermac.org
authors.forename: S
authors.initials: S
authors.lastname: Lingaratnam
authors.forename: A
authors.initials: A
authors.lastname: Mellerick
authors.forename: L J
authors.initials: LJ
authors.lastname: Worth
authors.forename: M
authors.initials: M
authors.lastname: Green
authors.forename: S
authors.initials: S
authors.lastname: Guy
authors.forename: S
authors.initials: S
authors.lastname: Kirsa
authors.forename: M
authors.initials: M
authors.lastname: Slavin
authors.forename: W
authors.initials: W
authors.lastname: Renwick
authors.forename: R
authors.initials: R
authors.lastname: Filshie
authors.forename: K A
authors.initials: KA
authors.lastname: Thursky
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration* / Q000592:standards*; D005240:Feasibility Studies; D006801:Humans; D009503:Neutropenia / Q000453:epidemiology / Q000628:therapy*; D010351:Patient Discharge / Q000592:standards*; D010865:Pilot Projects; D017064:Process Assessment, Health Care / Q000458:organization & administration / Q000592:standards; D011446:Prospective Studies; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology
keywords: ambulatory care; feasibility; neutropenic fever; organisational readiness; risk stratification